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Greater auricular and ulnar nerve damage in leprosy: clinical and electrophysiological comparison

Abstract
Clinically leprosy can have varied presentations ranging from an insignificant skin lesion to extensive disease causing profound disability and disfigurement by damaging peripheral nerves, eyes, bones and other tissues. Peripheral nerve involvement occurs sooner or later in the disease course leading to gross deformities and disabilities. Deformities in leprosy are secondary to nerve damage. However, by the time it clinically manifests, the nerve damage may already be quite advanced. If the preclinical damage is detected early, it can be prevented largely. The study was conducted in the Department of Dermatology, Venereology & Leprosy and Department of Neurology, Indira Gandhi Medical College, Shimla over a period of one year. This electrophysiological study included 20 patients with clinical manifestations of leprosy. 15/20 (75%) belonged to BL/LL types. 18 patients (90%) were multibacillary and 2(10%) were paucibacillary types. Nerve conduction velocity, amplitude and latency of greater auricular and ulnar sensory nerves were done. We found reduced conduction velocities, changes in latency and amplitude in the affected nerves. Ulnar nerve was more commonly involved than the greater auricular nerve. Out of 32 thickened ulnar nerves clinically, only 12 nerves (37.5%) had nerve function impairment. Two non-thickened nerves (2.5%) also had sensory impairment; in contrast 24 thickened nerves had normal functions. Thus, Nerve Conduction Studies can help in detection of early nerve impairment in some cases which otherwise may not be detected clinically. While overall these investigations appear to have limited value in diagnosis of disease and their prognostic value in monitoring the disease progression/response to intervention should be determined by follow-up studies. Valid conclusions with wider application value can only be drawn after carrying out follow up studies on a significant number of leprosy cases.

More information

Type
Journal Article
Author
Gupta P
Mainra A
Sharma S
Shanker S